Mediation intake form 2026

1. Click ‘Get Form’ to open the mediation intake form in the editor.
2. Begin by entering your name and the date at the top of the form. This ensures that your submission is properly dated and attributed.
3. Fill in your address, including city, state, and ZIP code. Accurate contact information is crucial for follow-up communications.
4. Provide your home, cell, and work phone numbers along with your email address. This allows for multiple ways to reach you regarding your case.
5. Indicate your employment details by filling in the name of your employer, position, employment status (full-time or part-time), and years employed.
6. Complete personal details such as date of birth and information about your spouse, including their name and marriage details.
7. Answer questions regarding children, abuse history, counseling experiences, and legal representation. Be honest to ensure appropriate support.
8. Finally, indicate how you found out about the service and whether you would like to send a thank-you note to a referral source.

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